Celiac Disease, Gluten Sensitivity, and Your Fertility

I wrote this article for the American Fertility Association. 

May is Celiac Awareness Month.  Celiac disease, also called gluten-sensitive enteropathy, is a hereditary, multi-system autoimmune disorder triggered by gluten, a protein found in wheat, rye, barley, malt, brewer’s yeast and, sometimes, oats.  Eating foods with gluten causes diarrhea, abdominal pain, bloating, malabsorption of nutrients, anemia, gynecological problems, eczema, skin rashes, weight loss, migraines, joint pain, tingling in the hands and feet, and neurological problems, including “brain fog” and ADHD-like behavior.  Early diagnosis of celiac disease is important because if left untreated, the disorder can result in serious damage to the small intestine and other parts of the body.  A person with celiac disease must avoid all such foods. Celiac disease is diagnosed by blood test.  The condition affects 1 out of every 133 people in the United States, or approximately 3 million people.

Many others may suffer from celiac’s troublesome cousin, non-celiac gluten sensitivity, a distinctly different diagnosis.  Alessio Fasano, M.D., medical director of the University of Maryland Center for Celiac Research, suggests that gluten problems are on a spectrum. Symptoms for those at the celiac end of the spectrum can be life threatening.  Those at the non-celiac gluten sensitivity end of the spectrum have similar symptoms to celiac but can heal bowels, body, and brain by switching to a gluten-free diet.  What is often deemed IBS (Irritable Bowel Syndrome) may in fact be problems with gluten.

Celiac disease and gluten sensitivity have been rising over the last 50 years.  In his book Wheat Belly:  Lose the wheat, Lose the weight, and find your path back to health (2011), cardiologist William Davis, M.D. offers research and clinical evidence that people are developing gluten-spectrum problems because of genetically-modified wheat.  There is a lot more gluten in the average American diet than in years past.  In an article entitled, “Celiac disease: On the rise” in the Mayo Clinic’s online research magazine, Discovery’s Edge, gastroenterologist Joseph Murray, M.D. reports, “Celiac disease was rare, but it’s now more common in all age groups…What’s more, Mayo has found a fourfold higher death risk for people with undiagnosed gluten intolerance.”  Dr. Murray notes that people and their family members with celiac disease as well as those with type 1 diabetes, chronic diarrhea, Irritable Bowel Syndrome, premature bone disease and infertility are at risk. Research from the Center for Celiac Research and Treatment estimates that 15 million people in the United States have gluten sensitivity without a diagnosis of celiac disease.  A Gluten Self-Assessment is available on the home page of the Institute for Specialized Medicine in San Diego.

There is currently no definitive blood test for gluten sensitivity.  However, naturopathic doctors have known for years that individuals can experience a variety of symptoms arising from gluten ingestion without having true celiac disease.  Dr. Nate Champion, ND, of Partners in Healing of Minneapolis says, “Over the past several years our understanding and knowledge of gluten sensitivity has grown, and research has begun to reveal evidence that gluten sensitivity is a separate clinical entity from celiac disease.  Gluten sensitivity is much more prevalent than celiac disease, affecting over 10 times as many individuals. So, how do you know if gluten is a problem for you?  One way is to try a gluten-free diet for at least four weeks or more and see how you feel.”  Dr. Champion and his naturopathic colleagues do specialized blood testing for gluten and other food sensitivities and allergies.  This type of blood test detects circulating food specific immunoglobulin class G (IgG) antibodies in the serum, to gluten and many other foods.

While celiac is known for its digestive and neurological problems, did you know that it can also be a cause of infertility?  Researchers have been studying links between celiac disease and female and male infertility, recurrent miscarriages, endometriosis and early menopause over the last 10 years.  It is suggested that some women who have been diagnosed with unexplained infertility may in fact have “silent” or undiagnosed celiac disease or gluten sensitivity.  Many women with PCOS (polycystic ovarian syndrome) are now eating gluten-free diets to reduce their body mass index (BMI) and regain their health and their fertility.  Men with celiac disease have been shown to have hypogonadism and abnormalities in sperm motility and morphology and semen quality. Overweight men and women may have higher estrogen and prolactin levels related to visceral fat around the middle, caused by gluten sensitivity.  People with celiac disease and related gluten problems may not feel well enough to have intercourse, thus complicating attempts to conceive.

A 2011 study in the Journal of Reproductive Medicine reports on an increased prevalence of celiac disease in patients with unexplained infertility in the United States.  The lead author, Janet Choi, M.D., a reproductive endocrinologist at the Center for Women’s Reproductive Care at Columbia University, and her colleagues suggest that gluten problems may lead to delayed menarche, early menopause, secondary amenorrhea, infertility, recurrent miscarriages and intrauterine growth restriction in pregnancy.  They recommend that testing for celiac disease be performed on women presenting with menstrual and reproductive problems.  For some women and men struggling with infertility, especially unexplained infertility, pursuing a gluten-free diet offers a low-cost, low-risk means to improve fertility, conception, and pregnancy.

Holistic chiropractor Eydi Bauer, D.C. talks about her struggles with infertility and other chronic health issues in her book, Life after bread: Get off gluten and reclaim your health (2009).  She writes that many processed foods have gluten in them so it takes some time and effort to learn how to cook with fresh ingredients.  She suggests substitution of a number of non-wheat, gluten-free whole grains such as amaranth, quinoa, brown or wild rice, buckwheat, corn, millet, sorghum, and teff.  Gluten-free flours, like rice, tapioca, almond, and coconut, can be substituted easily when baking.  Increasingly, companies are developing gluten-free baking mixes and frozen foods that make the change to healthier eating much easier than ever before.

Here’s the bottom line:  If you have infertility problems, especially unexplained infertility, ask your reproductive endocrinologist or OB/GYN to run a blood test for celiac disease.  If it comes back negative but you still have problems, try eating gluten-free anyway and see what you notice in terms of your bowel function, “brain fog”, or other manifestations of non-celiac gluten sensitivity.  Many people report easy weight loss—great for people who must reduce their BMI for fertility treatment—and fewer or no food cravings.  What have you got to lose as you build your family?  Here are some helpful resources for further exploration:

Bauer, E.  (2009)  Life after bread: Get off gluten and reclaim your health.  Fort Bragg: Cypress House.

Choi, J.M., Lebwohl, B., Wang, J., Lee, S.K., Murray, J.A., Sauer, M.V., and Green, P.H.  (2011).  Increased prevalence of celiac disease in patients with unexplained infertility in the United States. Journal of Reproductive Medicine.  May-Jun; 56(5-6):199-203.

Davis, W. (2011). Wheat Belly:  Lose the wheat, lose the weight, and find your path back to health.  Emmaus:  Rodale Bookes.

Freeman, H.J.  (2010).  Reproductive changes associated with celiac disease.  World Journal of Gastroenterology.  December 14; 16(46): 5810–5814.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001971/

Green, P. (2010). Celiac Disease:  A Hidden Epidemic.  New York: William Morrow.

Khoshbaten, M., Rostami, Nejad M., et al. (2011). Fertility disorder associated with celiac disease in males and females: fact or fiction. Journal of Obstetrics & Gynaecology.  Oct.: 37 (10): 1308-12.

Stephansson, O., Falconer, H., & Ludvigsson, J. (2011) Risk of endometriosis in 11,000 women with celiac disease. Human Reproduction. Oct;26(10):2896-901. doi: 10.1093/humrep/der263. Epub 2011 Aug 12. http://www.ncbi.nlm.nih.gov/pubmed/21840904











Deborah S. Simmons, PhD, LMFT has been a member of the American Society for Reproductive Medicine Mental Health Professional Group since 1998.  She works with straight and LGBT individuals and couples who are building their families through fertility treatment, including donor eggs, donor sperm, and surrogacy.  Dr. Simmons is the co-owner of Partners in Healing of Minneapolis at drdeborahsimmons.com and www.pih-mpls.com.  She is a member of the American Fertility Association Mental Health Advisory Council.




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